1720063159 NPI number — DR. DEBORAH V FISHMAN MD

Table of content: DR. DEBORAH V FISHMAN MD (NPI 1720063159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720063159 NPI number — DR. DEBORAH V FISHMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHMAN
Provider First Name:
DEBORAH
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRUNWALD
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720063159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
984 N BROADWAY
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10701-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-476-8877
Provider Business Mailing Address Fax Number:
914-476-4754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
984 N BROADWAY
Provider Second Line Business Practice Location Address:
STE 307
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-476-8877
Provider Business Practice Location Address Fax Number:
914-476-4754
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0201X , with the licence number:  1382471 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 1382471 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 78805699 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 176171P . This is a "EMBLEM HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 185655 . This is a "CHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3555631 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00609898 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138247A2B . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 176171P . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6241549 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0138035 . This is a "EMBLEM HEALTH GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5N9991 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 138247S . This is a "HEALTHCARE PARTNERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2932193 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01831542 . This is a "HEALTHPLUS-AMERIGROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 201500700026 . This is a "AFFINITY HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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